mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

移动医疗提供叙事干预，以增加马拉维艾滋病毒感染者的宫颈癌筛查

• 批准号: 9979152
• 负责人: Haeok Lee
• 金额: $ 21.53万
• 依托单位: UNIVERSITY OF MASSACHUSETTS BOSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-23 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979152
• 关键词: AIDS/HIV problem; Acetic Acids; Active Learning; Acute; Address; Adherence; African; Area; Awareness; Behavior; Car Phone; Caring; Cellular Phone; Cervical Cancer Screening; Charge; Communities; Computer Assisted; Country; Data; Data Collection; Development; Diagnosis; Diffusion; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Electricity; Emotional; Enrollment; Ethnography; Evaluation; Evidence based intervention; Foundations; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health behavior; Health behavior change; Health education; Healthcare; Home environment; Human Papillomavirus; Infection; Intervention; Interview; Knowledge; Learning; Lesion; Low Literacy Population; Malawi; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuals; Methods; Morbidity - disease rate; Outcome; Outcomes Research; Penetration; Personal Satisfaction; Phase; Population; Prevention; Procedures; Process; Public Health Informatics; Quality of Care; Randomized; Randomized Clinical Trials; Research; Resources; Rural; Screening for cancer; Self Efficacy; Self Management; Services; Social support; Standardization; Support Groups; System; Tablets; Testing; Translating; Visual; Woman; Work; arm; attentional control; base; behavior change; cervical cancer prevention; clinical practice; cohesion; control trial; cost; cost effective; cost effectiveness; disorder prevention; effective intervention; effectiveness testing; electronic data; evidence base; experimental study; global health; handheld mobile device; health belief; health care settings; health training; implementation strategy; improved; innovation; interactive multimedia; intervention effect; literacy; low income country; mHealth; member; mortality; novel; operation; pedagogy; premalignant; prevent; programs; prospective; recruit; rural area; rural residence; screening; social media; theories; uptake; wireless fidelity

Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV) in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in the prevention of CC but the availability of CC screening does not automatically translate into their utilization among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence- based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including cancer screening. In addition, narrative interventions such as storytelling made available through social media holds the promise of engaging WLWHIV in more active participation in health prevention/self-management. This study addresses the following specific aims: Phase I: Developmental Phase: Develop intervention Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted health messages that are consistent with the situation-specific theory and the desired behavior (CC screening). Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT) Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2: mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15 established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention. Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that it attempts to integrate CC screening into the HIV support group system already in place in Malawi and develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed study is significant because of its potential to improve CC prevention by equipping Malawian WLWHIV with self-confidence with cultural and evidence-based strategies to increase CC screening uptakes.

宫颈癌是感染艾滋病毒的妇女发病和死亡的主要原因 在马拉维。筛查和治疗患有癌前病变的妇女已被证明是非常有效的， 预防CC，但CC筛查的可用性并不自动转化为其使用 在WLWHIV中。.在WLWHIV中预防HPV相关宫颈癌，特别是在 在资源有限的环境中，缺乏以预防为导向的服务， 人们对急性疾病的治疗是有问题的。文化定制和证据- 需要采取基于基础的干预措施，以增加筛查率。讲故事的叙事干预特别适用于 承诺作为一种手段，使弱势群体（通常是低识字率）参与积极的健康行为，包括 癌症筛查此外，通过社交媒体提供的叙事干预，如讲故事， 有望使WLWHIV更积极地参与健康预防/自我管理。 这项研究涉及以下具体目标： 第一阶段：发展阶段：制定干预措施 具体目标1：我们将根据以下方面的真实故事，开展互动式多媒体干预： 马拉维WLWHIV、当地社区领导人和马拉维卫生保健提供者， 与特定情况理论和期望行为一致的健康信息（CC筛选）。 第二阶段：实施阶段：开展试点随机临床试验（RCT） 具体目标2：我们将进行一项试点RCT，分为三组（第1组：讲故事+移动健康;第2组： mHealth;和第3组：注意力控制; N=180），以评估可行性、可接受性和初步 在WLWHIV人群中通过移动健康（平板电脑）提供的叙述性干预措施的有效性。我们将选出15名 在马拉维利隆圭地区的农村地区建立艾滋病毒支助小组， 干预策略（组1、2或3）。在每一个选定的艾滋病毒支助团体中， 将前瞻性招募愿意参与研究的患者。调查结果和经验学习 从这项研究中获得的信息将为更大规模的试验奠定基础，以测试干预措施的有效性。 虽然拟议的实施战略是循证和有希望的，但它在艾滋病毒中的使用是新颖的。 支持小组设置和移动健康交付。需要在移动健康环境中进行可行性测试 在对低收入国家的有效性进行更大规模的评估之前。该项目的创新之处在于， 它试图将CC筛查纳入马拉维已经存在的艾滋病毒支持小组系统， 开发一个适合当地的小说叙事干预，是文化和识字敏感。拟议 这项研究意义重大，因为它有可能通过为马拉维WLWHIV配备 自信与文化和证据为基础的战略，以增加CC筛查的吸收。